Inflammatory bowel disease
Till about 3 decades ago, inflammatory bowel disease (IBD) was considered as non-existent in our country. However, since that time several reports of IBD, mainly ulcerative colitis have been published. More recently, Crohn’s disease is also being reported from the country. This trend of UC appearing first in a population followed by CD also appears to be true in other developing nations. A substantial increase in the rates of CD over UC in the last few decades is reported from developed nations as well. Of the other epidemiological factors, an increased risk of CD and lower risk of UC in smokers is established in adults. However, it appears that smoking increases the risk of IBD in children. The etiology of IBD remains elusive. Within the triad of genetics, immunity and antigen responsible for the development of IBD, maximum advances have been made in the field of immune aberrations and this is being exploited to treat the disease. It is well established that IBD results from a disordered immune system in the gut, in response to an unidentified antigen in a predisposed individual. The immune response is enhanced and revolves around antigen-presenting cells, CD 4 T-lymphocytes and tumor necrosis factor alpha. CD results from an enhanced Th1 activity. The pathogenesis of UC is less clear but appears to be humoral. Advances in diagnostics include the availability of serology, ultrasound and nuclear scans, none of which have been tried in our setting where infectious diseases and tuberculosis is rampant. Growth failure and the importance of nutrition in IBD, especially CD, cannot be underemphasized. In many situations nutritional interventions have been used solely as a form of therapy for CD. Newer steroid molecules with minimal systemic effects are also being considered. Other treatment options highlighted are the use of immunosuppressive agents, biologic agents and role of surgery.
Key wordsInflammatory bowel disease Ulcerative colitis Crohn’s disease
Glickman RM. Inflammatory bowel disease. In : Fauci AS ed.Harrison’s Principles of Internal Medicine
. 14th edn. McGraw-Hill 1998; 1632-1645.Google Scholar
Goenka MK, Kochhar R, Mehta SK. Spectrum of lower gastrointestinal hemorrhage: An endoscopic study of 166 patients.Indian J Gastroenterol
1993; 12 : 129–131.PubMedGoogle Scholar
Pai CG, Khandige GK. Is Crohn’s disease rare in India?Indian J Gastroenterol
, 2000; 19: 17–20.PubMedGoogle Scholar
Murch SM. Inflammatory bowel diseasees. In: Michael Gracey and Walker-Smith JA, eds.Diarrheal Diseases
. Nestle Nutrition Workshop Series; Vol. 38, Nestle Ltd., Vevey/Lippincort-Raven Publishers; Philadelphia, 1997; 265–275.Google Scholar
Thompson NP, Montgomery SM, Wadsworth ME, Pounder RE, Wakefield AJ. Early determinants of inflammatory bowel disease: Use of two national longitudinal birth cohorts.Eur J Gastroenterol Hepatol
2000; 12 : 25–30.PubMedCrossRefGoogle Scholar
Lashner BA, Shaheen NJ, Hanauer SB, Kirschner BS. Passive smoking is associated with an increased risk of developing inflammatory bowel disease.Am J Gastroenterol
1993; 88: 356–359.PubMedGoogle Scholar
Bonapace CR and Mays BA. The effect of mesalamine and nicotine in the treatment of inflammatory bowel disease.Ann Pharma
1997; 31: 907–913.Google Scholar
Polito JM, Rees RC, Childs B, Mendeloff AI, Harris ML, Bayless TM. Preliminary evidence for genetic anticipation in Crohn’s disease.Lancet
1996; 347: 798–800.PubMedCrossRefGoogle Scholar
Danze PM, Colombel JF, Jacquot Set al.
Association of HLA class II genes with susceptibility to Crohn’s disease.Gut
1996; 39: 69–72.PubMedCrossRefGoogle Scholar
Cho JH, Fu Y, Kirschner BS, Hanauer SB. Confirmation of a susceptibility locus IBD I for Crohn’s disease on chromosome 16.Gastroenterology
1997; 12: A 948.Google Scholar
Mayer L, Yio XY, Lin A, Panja A. Pathogenesis of IBD.Mt Sinai J Med
1996; 63: 202–209.PubMedGoogle Scholar
Sartor RB. Cytokines in intestinal inflammation: Pathophysiological and clinical considerations.Gastroenterology
1994; 106 : 633–539.Google Scholar
Ekbom A, Wakefield AJ, Zach M, Adamin HO. Perinatal measles infection and subsequent Crohn’s disease.Lancet
1994; 344: 508–510.PubMedCrossRefGoogle Scholar
Hyams J, Davis P, Lerer Tet al.
Clinical outcome of ulcerative proctitis in childhood.J Pediatr Gastroenterol Nutr
1997; 25: 149–152.PubMedCrossRefGoogle Scholar
Hyams JS. Extraintestinal manifestations of inflammatory bowel disease in children.J Pediatr Gastroenterol Nutr
1994; 19: 7–21.PubMedCrossRefGoogle Scholar
Griffiths AM, Zachos M. Antineutrophil cytoplasmic antibodies andanti-Sacchromyces cerevisiae
antibody: Clinical tools or clues for research?J Pediatr Gastroenterol Nutr
2000; 30 : 1–2.PubMedGoogle Scholar
Haber HP, Busch A, Ziebach R, Stern. Bowel wall thickness measured by ultrasound as a marker of Crohn’s disease activity in children.Lancet
2000; 355: 1239–1240.PubMedCrossRefGoogle Scholar
Ludwig D, Weiner S, Bruning A, Schwarting K, Jantschek G, Strange EF. Mesenteric blood flow is related to disease activity and risk of relapse in Crohn’s disease. A prospective followup study.Am J Gastroenterol
1999; 94: 2942–2950.PubMedCrossRefGoogle Scholar
Cucchiara S, Celentano C, de Magistris T, Montrisci A, Iula VD, Fecarotta S. Colonoscopy and technetium — 99m white cell scan in children with suspected inflammatory bowel disease.J Pediatr
1999; 15: 727–732.Google Scholar
Lofberg R, Danielsson A, Suhr Oet al.
Oral budenoside versus prednisolone in patients with active extensive and left-sided ulcerative colitis.Gastroenterology
1996; 110: 1713–1718.PubMedCrossRefGoogle Scholar
Feagan BG, Rochon J, Fedorak RNet al.
Methotrexate for the treatment of Crohn’s disease. The North American Crohn’s Study Group Investigators.N Engl J Med
1995; 332: 292–297PubMedCrossRefGoogle Scholar
Vohra P, Burroughs MH, Hodes DSet al.
Disseminated nocardiosis complicating medical therapy in Crohn’s disease.J Pediatr Gastroenterol Nutr
1997; 25: 233–235.PubMedCrossRefGoogle Scholar
Dubinsky MC, Lamothe S, Yang HYet al.
Pharmacogenomics and metabolite measurement for 6-Mercaptopurine therapy in inflammatory bowel disease.Gastroenterology
2000; 118: 706–713.CrossRefGoogle Scholar
Lichtiger S, Present DH, Kornbluth Aet al.
Cyclosporine in severe ulcerative colitis refractory to steroid therapy.N Engl J Med
1994; 330: 1841–1845.PubMedCrossRefGoogle Scholar
Ramakrishna J, Langhans N, Calenda K, Grand RJ, Verhave M. Combined use of cyclosporine and azathioprine or 6-Mercaptopurine in pediatric inflammatory bowel disease.J Pediatr Gastroenterol Nutr
1996; 22: 296–302.PubMedCrossRefGoogle Scholar
Lowry PW, Weaver AL, Tremaine WJ, Sandborn WJ. Combination therapy with oral tacrolimus (FK 506) and azathioprine or 6-mercaptopurine for treatment refractory CD perianal fistulae.Inflammatory Bowel Disease
1999; 5: 239–245.Google Scholar
Gaffney PR, Doyle CT, Gaffney A, Hogan J, Hayes DP, Annis P. Paradoxical response to heparin in 10 patients with ulcerative colitis.Am J Gastroenterol
1995; 90: 220–223.PubMedGoogle Scholar
Targan SR, Hanauer SB, van Deventei Set al.
Short term study of chimeric, monoclonal antibody CA2 to tumor necrosis factor for Crohn’s disease. Crohn’s disease CA2 study group.N Engl J Med
1997; 337: 1029–1035.PubMedCrossRefGoogle Scholar
Fell JM, Paintin M, Arnand-Battandier Fet al.
Mucosal healing and fall in pro-inflammatory cytokine mRNA induced by a specific oral diet in paediatric Crohn’s disease.Aliment Pharmacol Therap
2000; 14: 281–289.CrossRefGoogle Scholar
Sarigol S, Caufield M, Wyllie Ret al.
Heal pouch-anal anastomosis in children with ulcerative colitis.Inflammatory Bowel Disease
1996; 2: 82–87.CrossRefGoogle Scholar
Greenstein AJ. Cancer in inflammatory bowel disease.Mt Sinai J Med
2000; 67: 227–240.PubMedGoogle Scholar
© Dr. K C Chaudhuri Foundation 2000